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Shim J, Kang SH, Lee Y. Utility of block-matching and 3D filter for reproducibility of lung density and denoising in low-dose chest CT: A pilot study. Phys Med 2024; 124:103432. [PMID: 38996628 DOI: 10.1016/j.ejmp.2024.103432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Revised: 07/02/2024] [Accepted: 07/08/2024] [Indexed: 07/14/2024] Open
Abstract
PURPOSE This study aimed to acquire an image quality consistent with that of full-dose chest computed tomography (CT) when obtaining low-dose chest CT images and to analyze the effects of block-matching and 3D (BM3D) filters on lung density measurements and noise reduction in lung parenchyma. METHODS Using full-dose chest CT images, we evaluated lung density measurements and noise reduction in lung parenchyma images for low-dose chest CT. Three filters (median, Wiener, and the proposed BM3D) were applied to low-dose chest CT images for comparison and analysis with images from full-dose chest CT. To evaluate lung density measurements, we measured CT attenuation at the 15th percentile of the lung CT histogram. The coefficient of variation (COV) and contrast-to-noise ratio (CNR) were used to evaluate the noise level. RESULTS The 15th percentile of the lung CT histogram showed the smallest difference between full- and low-dose CT when applying the BM3D filter, and the highest difference between full- and low-dose CT without filters (full-dose = - 926.28 ± 0.32, BM3D = - 926.65 ± 0.32, and low-dose = - 959.43 ± 0.95) (p < 0.05). The COV was smallest when applying the BM3D filter, whereas the CNR was the highest (p < 0.05). CONCLUSIONS The results of the study prove that the BM3D filter can reduce image noise while increasing the reproducibility of the lung density, even for low-dose chest CT.
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Affiliation(s)
- Jina Shim
- Department of Diagnostic Radiology, Severance Hospital, Seoul, Republic of Korea
| | - Seong-Hyeon Kang
- Department of Radiological Science, Gachon University, Incheon, Republic of Korea.
| | - Youngjin Lee
- Department of Radiological Science, Gachon University, Incheon, Republic of Korea.
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2
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Vuković D, Budimir Mršić D, Ordulj I, Šarić F, Tandara M, Jerković K, Matana A, Tadić T. Is Type and Grade of Emphysema Important for Bone Mineral Density and Aortic Calcifications? J Clin Med 2024; 13:3947. [PMID: 38999515 PMCID: PMC11242253 DOI: 10.3390/jcm13133947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2024] [Revised: 06/27/2024] [Accepted: 07/03/2024] [Indexed: 07/14/2024] Open
Abstract
Background: Chronic obstructive pulmonary disease has extrapulmonary manifestations, such as cardiovascular diseases and osteoporosis. The purpose of this research was to determine the relationship between the type and extent of emphysema with thoracic aorta calcification (TAC) and bone mineral density (BMD) at Th4, Th8, and L1 vertebrae. Methods: Emphysema was described by computed tomography parameters (both Fleischner classification and low attenuation value percentage, LAV%) and the clinical FEV1/FVC ratio (Tiffeneau-Pinelli index, TI, TI < 0.7; TI > 0.7). Results: Of 200 included patients (median age 64, 33% women), signs of clinical obstruction (TI) were observed in 104 patients, which had significantly lower BMD and more heavy TAC. BMD correlated negatively with LAV%, Rho = -0.16 to -0.23, while a positive correlation of aortic calcification with LAV% was observed, Rho = 0.30 to 0.33. Multiple linear regression showed that age and TI < 0.7 were independent predictors of BMD, β = -0.20 to -0.40, and β = -0.21 to -0.25; age and hypercholesterolemia were independent predictors of TCA, β = 0.61 and β = 0.19. Conclusions: Clinical TI and morphological LAV% parameters correlated with BMD and TAC, in contrast to Fleischer-graded emphysema, which showed no correlation. However, only TI was an independent predictor of BMD, while the morphologically described type and extent of emphysema could not independently predict any extrapulmonary manifestation.
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Affiliation(s)
- Danica Vuković
- Clinical Department of Diagnostic and Interventional Radiology, University Hospital Split, Šoltanska 2, 21000 Split, Croatia; (D.V.); (I.O.); (F.Š.); (M.T.); (K.J.)
| | - Danijela Budimir Mršić
- Clinical Department of Diagnostic and Interventional Radiology, University Hospital Split, Šoltanska 2, 21000 Split, Croatia; (D.V.); (I.O.); (F.Š.); (M.T.); (K.J.)
- School of Medicine, University of Split, Šoltanska 2, 21000 Split, Croatia
- University Department of Health Studies, University of Split, Ruđera Boškovića 35, 21000 Split, Croatia;
| | - Ivan Ordulj
- Clinical Department of Diagnostic and Interventional Radiology, University Hospital Split, Šoltanska 2, 21000 Split, Croatia; (D.V.); (I.O.); (F.Š.); (M.T.); (K.J.)
| | - Frano Šarić
- Clinical Department of Diagnostic and Interventional Radiology, University Hospital Split, Šoltanska 2, 21000 Split, Croatia; (D.V.); (I.O.); (F.Š.); (M.T.); (K.J.)
| | - Mirko Tandara
- Clinical Department of Diagnostic and Interventional Radiology, University Hospital Split, Šoltanska 2, 21000 Split, Croatia; (D.V.); (I.O.); (F.Š.); (M.T.); (K.J.)
| | - Kristian Jerković
- Clinical Department of Diagnostic and Interventional Radiology, University Hospital Split, Šoltanska 2, 21000 Split, Croatia; (D.V.); (I.O.); (F.Š.); (M.T.); (K.J.)
| | - Antonela Matana
- University Department of Health Studies, University of Split, Ruđera Boškovića 35, 21000 Split, Croatia;
| | - Tade Tadić
- Clinical Department of Diagnostic and Interventional Radiology, University Hospital Split, Šoltanska 2, 21000 Split, Croatia; (D.V.); (I.O.); (F.Š.); (M.T.); (K.J.)
- School of Medicine, University of Split, Šoltanska 2, 21000 Split, Croatia
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3
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Inoue K, Matsukawa H, Kasai Y, Edamitsu K, Matsumoto K, Suetsugu Y, Hirose TA, Fukunaga JI, Shioyama Y, Sasaki T. Difference in target dose distributions between Acuros XB and collapsed cone convolution/superposition and the impact of the tumor locations in clinical cases of stereotactic ablative body radiotherapy for lung cancer. J Cancer Res Ther 2023; 19:1261-1266. [PMID: 37787293 DOI: 10.4103/jcrt.jcrt_1740_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
Objectives The objective of the study is to analyze the difference in target dose distributions between Acuros XB (AXB) and collapsed cone convolution (CCC)/superposition and the impact of the tumor locations in clinical cases of stereotactic ablative body radiotherapy (SABR) for lung cancer. Materials and Methods Ninety-six patients underwent SABR for lung cancers Kyushu University Hospital from 2014 to 2017. We recalculated clinical plans originally calculated by AXB using CCC with the identical monitor units (MUs) and beam arrangements. We calculated the following dosimetric parameters: maximum dose (Dmax), minimum dose (Dmin), homogeneity index (HI), conformity index (CI), and D95 of the planning target volume (PTV). We investigated the difference between the results of two calculations and examined the impact of tumor location. Moreover, we determined the target central dose using a thorax phantom and assessed the calculation accuracy of the two algorithms for each fraction. Results CCC significantly overestimated the dose to PTV, compared to AXB (P < 0.05). The mean differences of Dmax, Dmin, and D95 were 1.17, 1.95, and 1.85 Gy, respectively. The mean differences of HI and CI were 0.02 and - 0.06. Dmin, HI, and D95 had significant correlations with the tumor location, and the difference was greater when the PTV was included the chest wall (P < 0.05). The discrepancy between the calculated and irradiated dose was 2.48% for CCC, whereas it was 0.14% for AXB. Conclusions We demonstrated that CCC significantly overestimated the dose to PTV relative to AXB in clinical cases of lung SABR.
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Affiliation(s)
- Keiki Inoue
- Department of Health Sciences, Division of Medical Quantum Radiation Sciences, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Hideaki Matsukawa
- Department of Radiology, Hospital of University of Occupational and Environmental Health, Fukuoka, Japan
| | - Yuki Kasai
- Department of Radiology, Nagoya City University Hospital, Nagoya, Japan
| | - Kana Edamitsu
- Department of Radiology, Kitakyushu Municipal Medical Center, Japan
| | | | - Yoshiki Suetsugu
- Department of Health Sciences, Division of Medical Quantum Radiation Sciences, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Taka-Aki Hirose
- Department of Radiology, Medical Technology, Kyush University Hospital, Fukuoka, Japan
| | - Jun-Ichi Fukunaga
- Department of Radiology, Medical Technology, Kyush University Hospital, Fukuoka, Japan
| | | | - Tomonari Sasaki
- Department of Health Sciences, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan
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4
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Strange C, McElvaney NG, Vogelmeier CF, Marin-Galiano M, Buch-Haensel M, Zhang X, Chen Y, Vit O, Wencker M, Chapman KR. The effect of exacerbations on lung density in α 1-antitrypsin deficiency. ERJ Open Res 2023; 9:00457-2022. [PMID: 36923570 PMCID: PMC10009703 DOI: 10.1183/23120541.00457-2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 11/23/2022] [Indexed: 12/24/2022] Open
Abstract
Background Acute exacerbations of COPD (AECOPD) have unclear impacts on emphysema measurement using computed tomography (CT)-derived 15th percentile lung density (PD15). The aim of this study was to assess the influence of AECOPD on PD15 lung density in α1-antitrypsin deficiency. Methods In a post hoc analysis of the RAPID (Randomised Trial of Augmentation Therapy in α1-Proteinase Inhibitor Deficiency) trial, raw marginal residuals of PD15 (measured - predicted) were determined by fitting a regression line to individual patient CT data. These deviations from the expected slope were compared by age, sex, baseline forced expiratory volume in 1 s, diffusing capacity of the lungs for carbon monoxide % predicted and PD15, inhaled corticosteroid use and treatment group. Results Positive and negative residuals (reflecting higher or lower lung density than predicted from regression) were observed, which declined in magnitude over time following AECOPD events. Logistic regression confirmed a limited effect of patient characteristics on the absolute size of residuals, whereas AECOPD within 6 weeks of CT had a notable effect versus no AECOPD within 6 weeks (OR 5.707, 95% CI 3.375-9.652; p<0.0001). Conclusion AECOPD result in higher or lower CT lung density estimates; the effect is greatest in the 2 weeks immediately after an AECOPD and persists for <6 weeks. Patient characteristics were less relevant than AECOPD within 6 weeks, supporting the reliability of PD15 as a measure of lung density. An exacerbation-free period prior to CT scan is advisable to reduce signal-to-noise ratio in future clinical trials.
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Affiliation(s)
- Charlie Strange
- Division of Pulmonary and Critical Care Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - N Gerard McElvaney
- Irish Centre for Genetic Lung Disease, Beaumont Hospital, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Claus F Vogelmeier
- Department of Medicine, Pulmonary and Critical Care Medicine, University Medical Center Giessen and Marburg, Philipps-University Marburg, Member of the German Center for Lung Research (DZL), Marburg, Germany
| | - Marcos Marin-Galiano
- M.A.R.C.O. GmbH & Co. KG Institute for Clinical Research and Statistics, Düsseldorf, Germany
| | | | - Xiang Zhang
- Biostatistics, CSL Behring, King of Prussia, PA, USA
| | - Younan Chen
- Biostatistics, CSL Behring, King of Prussia, PA, USA
| | - Oliver Vit
- Clinical Research and Development, CSL Behring, Bern, Switzerland
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5
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Jardim JR, Casas-Maldonado F, Fernandes FLA, Castellano MVCDO, Torres-Durán M, Miravitlles M. Update on and future perspectives for the diagnosis of alpha-1 antitrypsin deficiency in Brazil. J Bras Pneumol 2021; 47:e20200380. [PMID: 34076174 PMCID: PMC8332724 DOI: 10.36416/1806-3756/e20200380] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 01/25/2021] [Indexed: 12/05/2022] Open
Abstract
Alpha-1 antitrypsin deficiency (AATD) is a rare genetic disorder caused by a mutation in the SERPINA1 gene, which encodes the protease inhibitor alpha-1 antitrypsin (AAT). Severe AATD predisposes individuals to COPD and liver disease. Early diagnosis is essential for implementing preventive measures and limiting the disease burden. Although national and international guidelines for the diagnosis and management of AATD have been available for 20 years, more than 85% of cases go undiagnosed and therefore untreated. In Brazil, reasons for the underdiagnosis of AATD include a lack of awareness of the condition among physicians, a racially diverse population, serum AAT levels being assessed in a limited number of individuals, and lack of convenient diagnostic tools. The diagnosis of AATD is based on laboratory test results. The standard diagnostic approach involves the assessment of serum AAT levels, followed by phenotyping, genotyping, gene sequencing, or combinations of those, to detect the specific mutation. Over the past 10 years, new techniques have been developed, offering a rapid, minimally invasive, reliable alternative to traditional testing methods. One such test available in Brazil is the A1AT Genotyping Test, which simultaneously analyzes the 14 most prevalent AATD mutations, using DNA extracted from a buccal swab or dried blood spot. Such advances may contribute to overcoming the problem of underdiagnosis in Brazil and elsewhere, as well as being likely to increase the rate detection of AATD and therefore mitigate the harmful effects of delayed diagnosis.
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Affiliation(s)
- José R Jardim
- . Centro de Reabilitação Pulmonar, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo (SP) Brasil
| | | | - Frederico Leon Arrabal Fernandes
- . Divisão de Pneumologia, Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo (SP) Brasil
| | | | - María Torres-Durán
- . Departamento de Neumología, Hospital Álvaro Cunqueiro, Vigo, España
- . Instituto de Investigación Sanitaria Galicia Sur - IISGS - Vigo, España
| | - Marc Miravitlles
- . Departamento de Neumología, Hospital Universitario Vall d'Hebron, Barcelona, España
- . Vall d'Hebron Institut de Recerca - VHIR - Hospital Universitario Vall d'Hebron Barcelona, Barcelona, España
- . CIBER de Enfermedades Respiratorias - CIBERES - Barcelona, España
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6
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Qin S, Yu X, Ma Q, Lin L, Li Q, Liu H, Zhang L, Leng S, Han W. Quantitative CT Analysis of Small Airway Remodeling in Patients with Chronic Obstructive Pulmonary Disease by a New Image Post-Processing System. Int J Chron Obstruct Pulmon Dis 2021; 16:535-544. [PMID: 33688178 PMCID: PMC7936712 DOI: 10.2147/copd.s295320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 02/07/2021] [Indexed: 12/02/2022] Open
Abstract
Purpose To explore a practical marker for quantitatively analyzing the small airway remodeling in COPD by HRCT. Patients and Methods Twenty-four patients with COPD (GOLD I, n = 7; GOLD II, n = 8; GOLD III+IV, n = 9) and 14 healthy controls (7 normal pulmonary function; 7 small-airway disease (SAD)) were enrolled in the study as five groups, GOLD I, GOLD II, GOLD III+IV, normal and SAD. All subjects underwent HRCT and spirometry. With ISP 9.0, whole emphysema index (EI) and the airway parameters, including wall area (WA), lumen area (LA), airway area (AA) of the 3rd, 5th and 9th generations of bronchi, were measured successively. The ratio of LA/AA and WA/AA in the 3rd, 5th and 9th generations of bronchi were calculated and compared among groups. Results For the five groups, EI was increased only in GOLD III+IV group (P < 0.05), while the ratio of LA/AA (9-LA/AA) and WA/AA (9-WA/AA) in 9th generation of bronchi have significantly changed since SAD group (P < 0.05). There were significant correlation between FEV1generations of bronchi (r3 = 0.429, r5 = 0.583, r9 = 0.592, respectively, P < 0.05); FEV1% and WA/AA (r3 = –0.428, r5 = –0.532, r9 = –0.570, respectively, P < 0.05); as well as MMEF% and LA/AA (r3 = 0.421, r5 = 0.566, r9 = 0.610, respectively, P < 0.05); MMEF% and WA/AA (r3 = –0.421, r5 = –0.529, r9 = –0.593, respectively, P < 0.05). Conclusion Small airway remodeling has occurred in the early stage of COPD, while emphysema in the late stage of COPD. The 9-LA/AA and 9-WA/AA are accurate and practical markers for small airway remodeling of COPD.
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Affiliation(s)
- Shuyi Qin
- Department of Pulmonary and Critical Care Medicine, Qingdao Municipal Hospital, School of Medicine, Qingdao University, Qingdao, Shandong, People's Republic of China.,Respiratory Disease Key Laboratory of Qingdao, Qingdao Municipal Hospital, Qingdao, Shandong, People's Republic of China
| | - Xinjuan Yu
- Department of Pulmonary and Critical Care Medicine, Qingdao Municipal Hospital, School of Medicine, Qingdao University, Qingdao, Shandong, People's Republic of China.,Respiratory Disease Key Laboratory of Qingdao, Qingdao Municipal Hospital, Qingdao, Shandong, People's Republic of China
| | - Qianli Ma
- Department of Radiology, Qingdao Municipal Hospital, Qingdao, Shandong, People's Republic of China
| | - Li Lin
- Department of Pulmonary Medicine, Shandong Provincial Chest Hospital, Jinan, Shandong, People's Republic of China
| | - Qinghai Li
- Department of Pulmonary and Critical Care Medicine, Qingdao Municipal Hospital, School of Medicine, Qingdao University, Qingdao, Shandong, People's Republic of China.,Respiratory Disease Key Laboratory of Qingdao, Qingdao Municipal Hospital, Qingdao, Shandong, People's Republic of China
| | - Hong Liu
- Department of Pulmonary and Critical Care Medicine, Qingdao Municipal Hospital, School of Medicine, Qingdao University, Qingdao, Shandong, People's Republic of China.,Respiratory Disease Key Laboratory of Qingdao, Qingdao Municipal Hospital, Qingdao, Shandong, People's Republic of China
| | - Lei Zhang
- Department of Hospital Infection, Qingdao Municipal Hospital, Qingdao, Shandong, People's Republic of China
| | - Shuguang Leng
- Department of Internal Medicine, University of New Mexico School of Medicine, Albuquerque, NM, USA
| | - Wei Han
- Department of Pulmonary and Critical Care Medicine, Qingdao Municipal Hospital, School of Medicine, Qingdao University, Qingdao, Shandong, People's Republic of China.,Respiratory Disease Key Laboratory of Qingdao, Qingdao Municipal Hospital, Qingdao, Shandong, People's Republic of China
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7
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Wei X, Yu N, Ding Q, Ren J, Mi J, Bai L, Li J, Qi M, Guo Y. The features of AECOPD with carbon dioxide retention. BMC Pulm Med 2018; 18:124. [PMID: 30064410 PMCID: PMC6066936 DOI: 10.1186/s12890-018-0691-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Accepted: 07/16/2018] [Indexed: 11/10/2022] Open
Abstract
Background Chronic obstructive pulmonary disease (COPD) with carbon dioxide retention is associated with a worsening clinical condition and the beginning of pulmonary ventilation decompensation. This study aimed to identify the factors associated with carbon dioxide retention. Methods This was a retrospective study of consecutive patients with COPD (meeting the Global Initiative for Chronic Obstructive Lung Disease diagnostic criteria) hospitalized at The Ninth Hospital of Xi’an Affiliated Hospital of Xi’an Jiaotong University between October 2014 and September 2017. The baseline demographic, clinical, laboratory, pulmonary function, and imaging data were compared between the 86 cases with carbon dioxide retention and the 144 cases without carbon dioxide retention. Results Compared with the non-carbon dioxide retention group, the group with carbon dioxide retention had a higher number of hospitalizations in the previous 12 months (p = 0.013), higher modified Medical Research Council (mMRC) dyspnea scores (p = 0.034), lower arterial oxygen pressure (p = 0.018), worse pulmonary function (forced expiratory volume in one second/forced vital capacity [FEV1/FVC; p < 0.001], FEV1%pred [p < 0.001], Z5%pred [p = 0.004], R5%pred [p = 0.008], R5-R20 [p = 0.009], X5 [p = 0.022], and Ax [p = 0.011]), more severe lung damage (such as increased lung volume [p = 0.011], more emphysema range [p = 0.007], and lower mean lung density [p = 0.043]). FEV1 < 1 L (odds ratio [OR] = 4.011, 95% confidence interval [CI]: 2.216–7.262) and emphysema index (EI) > 20% (OR = 1.926, 95% CI: 1.080–3.432) were independently associated with carbon dioxide retention in COPD. Conclusion Compared with the non-carbon dioxide retention group, the group with carbon dioxide retention had different clinical, pulmonary function, and imaging features. FEV1 < 1 L and EI > 20% were independently associated with carbon dioxide retention in AECOPD. Trial registration ChiCTR-OCH-14004904. Registered 25 June 2014. Electronic supplementary material The online version of this article (10.1186/s12890-018-0691-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Xia Wei
- Department of Radiology, Xi'an Jiaotong University Medical College First Affiliated Hospital, Xi'an, China.,Department of Respiratory Medicine, The Ninth Hospital of Xi'an Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Nan Yu
- Department of Radiology, The Affiliated Hospital of Shaanxi University of Traditional Chinese Medicine, Xianyang, Shaanxi, China
| | - Qi Ding
- Department of Respiratory Medicine, The Ninth Hospital of Xi'an Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Jingting Ren
- Department of Respiratory Medicine, The Ninth Hospital of Xi'an Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Jiuyun Mi
- Department of Respiratory Medicine, The Ninth Hospital of Xi'an Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Lu Bai
- Department of Radiology, Xi'an Jiaotong University Medical College First Affiliated Hospital, Xi'an, China
| | - Jianying Li
- Department of Respiratory Medicine, Central Hospital of Xi'an Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Min Qi
- Department of Radiology, Shaanxi Provincial People's Hospital, Xi'an, China
| | - Youmin Guo
- Department of Radiology, Xi'an Jiaotong University Medical College First Affiliated Hospital, Xi'an, China.
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Campo MI, Pascau J, José Estépar RS. EMPHYSEMA QUANTIFICATION ON SIMULATED X-RAYS THROUGH DEEP LEARNING TECHNIQUES. PROCEEDINGS. IEEE INTERNATIONAL SYMPOSIUM ON BIOMEDICAL IMAGING 2018; 2018:273-276. [PMID: 30450153 PMCID: PMC6239425 DOI: 10.1109/isbi.2018.8363572] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Emphysema quantification techniques rely on the use of CT scans, but they are rarely used in the diagnosis and management of patients with COPD; X-ray films are the preferred method to do this. However, this diagnosis method is very controversial, as there are not established guidelines to define the disease, sensitivity is low, and quantification cannot be done. We developed a quantification method based on a CNN, capable of predicting the emphysema percentage of a patient based on an X-ray image. We used real CT scans to simulate X-ray films and to calculate emphysema percentage using the LAA%. The model developed was able to calculate emphysema percentage with an LAA% mean error of 3.96, and it obtained an AUC accuracy of 90.73% for an emphysema definition of ≥10%, with a mean sensitivity of 85.68%, significantly improving X-ray-based emphysema diagnosis.
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Affiliation(s)
- Mónica Iturrioz Campo
- Applied Chest Imaging Laboratory, Brigham and Women's Hospital, Boston, MA, USA
- Dept. de Bioingeniería e Ingeniería Aeroespacial, Universidad Carlos III de Madrid, Madrid, Spain
| | - Javier Pascau
- Dept. de Bioingeniería e Ingeniería Aeroespacial, Universidad Carlos III de Madrid, Madrid, Spain
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9
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Wei X, Ma Z, Yu N, Ren J, Jin C, Mi J, Shi M, Tian L, Gao Y, Guo Y. Risk factors predict frequent hospitalization in patients with acute exacerbation of COPD. Int J Chron Obstruct Pulmon Dis 2017; 13:121-129. [PMID: 29343951 PMCID: PMC5749567 DOI: 10.2147/copd.s152826] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Purpose COPD is a heterogeneous disease, and the available prognostic indexes are therefore limited. This study aimed to identify the factors associated with acute exacerbation leading to hospitalization. Patients and methods This was a retrospective study of consecutive patients with COPD (meeting the Global Initiative for Chronic Obstructive Lung Disease [GOLD] diagnostic criteria) hospitalized at the Ninth Hospital of Xi’an Affiliated Hospital of Xi’an Jiaotong University between October 2014 and September 2016. During follow-up after first hospitalization, the patients who had been rehospitalized within 1 year for acute exacerbation were grouped into the frequent exacerbation (FE) group, while the others were grouped into the infrequent exacerbation (IE) group. The baseline demographic, clinical, laboratory, pulmonary function, and imaging data were compared between the two groups. Results Compared with the IE group, the FE group had lower forced expiratory volume in 1 second (FEV1)/forced vital capacity (FVC) (P=0.005), FEV1%pred (P=0.002), maximal mid-expiratory flow (MMEF25–75%pred) (P=0.003), and ratio of carbon monoxide diffusion capacity to alveolar ventilation (DLCO/VA) (P=0.03) and higher resonant frequency (Fres; P=0.04). According to generations of bronchi, the percentage of the wall area (%WA) of lobes was found to be higher in the FE group. Emphysema index (EI), mean emphysema density (MED)whole and MEDleft lung in the FE group were significantly worse than in the IE group (P<0.05). Using logistic regression, exacerbation hospitalizations in the past year (odds ratio [OR] 14.4, 95% CI 6.1–34.0, P<0.001) and EI >10% (OR 2.9, 95% CI 1.2–7.1, P=0.02) were independently associated with frequent acute exacerbation of COPD (AECOPD) hospitalization. Conclusion Exacerbation hospitalizations in the past year and imaging features of emphysema (EI) were independently associated with FE hospitalization.
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Affiliation(s)
- Xia Wei
- Department of Radiology, The First Affiliated Hospital of Xi'an Jiaotong University.,Department of Respiratory Medicine, The Ninth Hospital of Xi'an Affiliated Hospital of Xi'an Jiaotong University, Xi'an
| | - Zhengquan Ma
- Department of Respiratory Medicine, The Ninth Hospital of Xi'an Affiliated Hospital of Xi'an Jiaotong University, Xi'an
| | - Nan Yu
- Department of Radiology, The Affiliated Hospital of Shaanxi University of Traditional Chinese Medicine, Shaanxi
| | - Jingting Ren
- Department of Respiratory Medicine, The Ninth Hospital of Xi'an Affiliated Hospital of Xi'an Jiaotong University, Xi'an
| | - Chenwang Jin
- Department of Radiology, The First Affiliated Hospital of Xi'an Jiaotong University
| | - Jiuyun Mi
- Department of Respiratory Medicine, The Ninth Hospital of Xi'an Affiliated Hospital of Xi'an Jiaotong University, Xi'an
| | - Meijuan Shi
- Department of Radiology, The First Affiliated Hospital of Xi'an Jiaotong University
| | - Libin Tian
- Department of Respiratory Medicine, The Ninth Hospital of Xi'an Affiliated Hospital of Xi'an Jiaotong University, Xi'an
| | - Yanzhong Gao
- Department of Radiology, The Ninth Hospital of Xi'an Affiliated Hospital of Xi'an Jiaotong University, Xi'an, People's Republic of China
| | - Youmin Guo
- Department of Radiology, The First Affiliated Hospital of Xi'an Jiaotong University
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Campos MA, Diaz AA. The Role of Computed Tomography for the Evaluation of Lung Disease in Alpha-1 Antitrypsin Deficiency. Chest 2017; 153:1240-1248. [PMID: 29175361 PMCID: PMC6026284 DOI: 10.1016/j.chest.2017.11.017] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2017] [Revised: 10/15/2017] [Accepted: 11/09/2017] [Indexed: 11/28/2022] Open
Abstract
Alpha-1 antitrypsin deficiency (AATD) is characterized by low serum levels of or dysfunctional alpha-1 proteinase inhibitor. In the lung parenchyma, this results in a loss of protection against the activity of serine proteases, particularly neutrophil elastase. The resultant imbalance in protease and antiprotease activity leads to an increased risk for the development of early-onset emphysema and COPD. As in traditional smoke-related COPD, the assessment of the severity and disease progression of lung disease in AATD is conventionally based on lung function; however, pulmonary function tests are unable to discriminate between emphysema and airways disease, the two hallmark pathologic features of COPD. CT imaging has been used as a tool to further characterize lung structure and evaluate therapeutic interventions in AATD-related COPD. Moreover, recent advances in quantitative CT have significantly improved our assessment of the lung architecture, which has provided investigators and clinicians with a more detailed evaluation of the extent and severity of emphysema and airways disease in AATD. In addition, serial CT imaging measures are becoming increasingly important, as they provide a tool to monitor emphysema progression. This review describes the principles of CT technology and the role of CT imaging in assessing pulmonary disease progression in AATD, including the effect of therapeutic interventions.
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Affiliation(s)
- Michael A Campos
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, University of Miami School of Medicine, Miami, FL.
| | - Alejandro A Diaz
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
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11
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Pathologic and Radiologic Correlation of Adult Cystic Lung Disease: A Comprehensive Review. PATHOLOGY RESEARCH INTERNATIONAL 2017; 2017:3502438. [PMID: 28270943 PMCID: PMC5320373 DOI: 10.1155/2017/3502438] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Revised: 12/11/2016] [Accepted: 12/18/2016] [Indexed: 12/17/2022]
Abstract
The presence of pulmonary parenchymal cysts on computed tomography (CT) imaging presents a significant diagnostic challenge. The diverse range of possible etiologies can usually be differentiated based on the clinical setting and radiologic features. In fact, the advent of high-resolution CT has facilitated making a diagnosis solely on analysis of CT image patterns, thus averting the need for a biopsy. While it is possible to make a fairly specific diagnosis during early stages of disease evolution by its characteristic radiological presentation, distinct features may progress to temporally converge into relatively nonspecific radiologic presentations sometimes necessitating histological examination to make a diagnosis. The aim of this review study is to provide both the pathologist and the radiologist with an overview of the diseases most commonly associated with cystic lung lesions primarily in adults by illustration and description of pathologic and radiologic features of each entity. Brief descriptions and characteristic radiologic features of the various disease entities are included and illustrative examples are provided for the common majority of them. In this article, we also classify pulmonary cystic disease with an emphasis on the pathophysiology behind cyst formation in an attempt to elucidate the characteristics of similar cystic appearances seen in various disease entities.
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12
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Kahnert K, Lucke T, Biertz F, Lechner A, Watz H, Alter P, Bals R, Behr J, Holle R, Huber RM, Karrasch S, Stubbe B, Wacker M, Söhler S, Wouters EFM, Vogelmeier C, Jörres RA. Transfer factor for carbon monoxide in patients with COPD and diabetes: results from the German COSYCONET cohort. Respir Res 2017; 18:14. [PMID: 28086884 PMCID: PMC5237203 DOI: 10.1186/s12931-016-0499-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Accepted: 12/30/2016] [Indexed: 03/11/2023] Open
Abstract
Background An impairment of CO diffusing capacity has been shown in diabetic patients without lung disease. We analyzed how diffusing capacity in patients with COPD is affected by the concurrent diagnosis of diabetes. Methods Data from the initial visit of the German COPD cohort COSYCONET were used for analysis. 2575 patients with complete lung function data were included, among them 358 defined as diabetics with a reported physician diagnosis of diabetes and/or specific medication. Pairwise comparisons between groups and multivariate regression models were used to identify variables predicting the CO transfer factor (TLCO%pred) and the transfer coefficient (KCO%pred). Results COPD patients with diabetes differed from those without diabetes regarding lung function, anthropometric, clinical and laboratory parameters. Moreover, gender was an important covariate. After correction for lung function, gender and body mass index (BMI), TLCO%pred did not significantly differ between patients with and without diabetes. The results for the transfer coefficient KCO were similar, demonstrating an important role of the confounding factors RV%pred, TLC%pred, ITGV%pred, FEV1%pred, FEV1/FVC, age, packyears, creatinine and BMI. There was not even a tendency towards lower values in diabetes. Conclusion The analysis of data from a COPD cohort showed no significant differences of CO transport parameters between COPD patients with and without diabetes, if BMI, gender and the reduction in lung volumes were taken into account. This result is in contrast to observations in lung-healthy subjects with diabetes and raises the question which factors, among them potential anti-inflammatory effects of anti-diabetes medication are responsible for this finding.
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Affiliation(s)
- Kathrin Kahnert
- Department of Internal Medicine V, University of Munich, Comprehensive Pneumology Center, Member of the German Center for Lung Research, Ziemssenstr. 1, 80336, Munich, Germany.
| | - Tanja Lucke
- Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, Ludwig-Maximilians-Universität München, Ziemssenstr. 1, 80336, Munich, Germany
| | - Frank Biertz
- Institute for Biostatistics, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Andreas Lechner
- Department of Internal Medicine IV, University of Munich, Ziemssenstr. 1, 80336, Munich, Germany
| | - Henrik Watz
- Pulmonary Research Institute at LungenClinic Grosshansdorf, Airway Research Center North, Member of the German Center for Lung Research, Woehrendamm 80, 22927, Grosshansdorf, Germany
| | - Peter Alter
- Department of Respiratory Medicine, University of Marburg, University Giessen and Marburg Lung Center (UGMLC), Member of the German Center for Lung Research, Baldingerstraße, 35043, Marburg, Germany
| | - Robert Bals
- Department of Internal Medicine V - Pulmonology, Allergology, Respiratory Intensive Care Medicine, Saarland University Hospital, Kirrberger Straße 1, 66424, Homburg, Germany
| | - Jürgen Behr
- Department of Internal Medicine V, University of Munich, Comprehensive Pneumology Center, Member of the German Center for Lung Research, Ziemssenstr. 1, 80336, Munich, Germany
| | - Rolf Holle
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München (GmbH) - German Research Center for Environmental Health, Member of the German Center for Lung Research, Comprehensive Pneumology Center Munich (CPC-M), Ingolstaedter Landstr. 1, 85764, Neuherberg, Germany
| | - Rudolf M Huber
- Department of Internal Medicine V, University of Munich, Comprehensive Pneumology Center, Member of the German Center for Lung Research, Ziemssenstr. 1, 80336, Munich, Germany
| | - Stefan Karrasch
- Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, Ludwig-Maximilians-Universität München, Ziemssenstr. 1, 80336, Munich, Germany.,Institute of Epidemiology I, Helmholtz Zentrum München - German Research Center for Environmental Health, Ingolstaedter Landstr. 1, 85764, Neuherberg, Germany
| | - Beate Stubbe
- Department of Internal Medicine B - Cardiology, Intensive Care, Pulmonary Medicine and Infectious Diseases, Scientific Division of Pneumology and Pneumological Epidemiology, University Medicine Greifswald, Ferdinand-Sauerbruch-Strasse, 17475, Greifswald, Germany
| | - Margarethe Wacker
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München (GmbH) - German Research Center for Environmental Health, Member of the German Center for Lung Research, Comprehensive Pneumology Center Munich (CPC-M), Ingolstaedter Landstr. 1, 85764, Neuherberg, Germany
| | - Sandra Söhler
- ASCONET Study Coordination Office, University of Marburg, Baldingerstraße, 35043, Marburg, Germany
| | - Emiel F M Wouters
- Department of Respiratory Medicine, Maastricht University Medical Center, P. Debyelaan 25, 6202 AZ, Maastricht, The Netherlands
| | - Claus Vogelmeier
- Department of Respiratory Medicine, University of Marburg, University Giessen and Marburg Lung Center (UGMLC), Member of the German Center for Lung Research, Baldingerstraße, 35043, Marburg, Germany
| | - Rudolf A Jörres
- Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, Ludwig-Maximilians-Universität München, Ziemssenstr. 1, 80336, Munich, Germany
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Hartley RA, Barker BL, Newby C, Pakkal M, Baldi S, Kajekar R, Kay R, Laurencin M, Marshall RP, Sousa AR, Parmar H, Siddiqui S, Gupta S, Brightling CE. Relationship between lung function and quantitative computed tomographic parameters of airway remodeling, air trapping, and emphysema in patients with asthma and chronic obstructive pulmonary disease: A single-center study. J Allergy Clin Immunol 2016; 137:1413-1422.e12. [PMID: 27006248 PMCID: PMC4852952 DOI: 10.1016/j.jaci.2016.02.001] [Citation(s) in RCA: 71] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2015] [Revised: 01/23/2016] [Accepted: 02/05/2016] [Indexed: 11/18/2022]
Abstract
Background There is a paucity of studies comparing asthma and chronic obstructive pulmonary disease (COPD) based on thoracic quantitative computed tomographic (QCT) parameters. Objectives We sought to compare QCT parameters of airway remodeling, air trapping, and emphysema between asthmatic patients and patients with COPD and explore their relationship with airflow limitation. Methods Asthmatic patients (n = 171), patients with COPD (n = 81), and healthy subjects (n = 49) recruited from a single center underwent QCT and clinical characterization. Results Proximal airway percentage wall area (%WA) was significantly increased in asthmatic patients (62.5% [SD, 2.2]) and patients with COPD (62.7% [SD, 2.3]) compared with that in healthy control subjects (60.3% [SD, 2.2], P < .001). Air trapping measured based on mean lung density expiratory/inspiratory ratio was significantly increased in patients with COPD (mean, 0.922 [SD, 0.037]) and asthmatic patients (mean, 0.852 [SD, 0.061]) compared with that in healthy subjects (mean, 0.816 [SD, 0.066], P < .001). Emphysema assessed based on lung density measured by using Hounsfield units below which 15% of the voxels lie (Perc15) was a feature of COPD only (patients with COPD: mean, −964 [SD, 19.62] vs asthmatic patients: mean, −937 [SD, 22.7] and healthy subjects: mean, −937 [SD, 17.1], P < .001). Multiple regression analyses showed that the strongest predictor of lung function impairment in asthmatic patients was %WA, whereas in the COPD and asthma subgrouped with postbronchodilator FEV1 percent predicted value of less than 80%, it was air trapping. Factor analysis of QCT parameters in asthmatic patients and patients with COPD combined determined 3 components, with %WA, air trapping, and Perc15 values being the highest loading factors. Cluster analysis identified 3 clusters with mild, moderate, or severe lung function impairment with corresponding decreased lung density (Perc15 values) and increased air trapping. Conclusions In asthmatic patients and patients with COPD, lung function impairment is strongly associated with air trapping, with a contribution from proximal airway narrowing in asthmatic patients.
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Affiliation(s)
- Ruth A Hartley
- Department of Infection, Inflammation and Immunity and Health Sciences, Institute for Lung Health, University of Leicester, Leicester, United Kingdom
| | - Bethan L Barker
- Department of Infection, Inflammation and Immunity and Health Sciences, Institute for Lung Health, University of Leicester, Leicester, United Kingdom
| | - Chris Newby
- Department of Infection, Inflammation and Immunity and Health Sciences, Institute for Lung Health, University of Leicester, Leicester, United Kingdom
| | - Mini Pakkal
- Department of Infection, Inflammation and Immunity and Health Sciences, Institute for Lung Health, University of Leicester, Leicester, United Kingdom
| | - Simonetta Baldi
- Department of Infection, Inflammation and Immunity and Health Sciences, Institute for Lung Health, University of Leicester, Leicester, United Kingdom
| | - Radhika Kajekar
- Department of experimental Medicine, Hoffmann-La Roche, Nutley, NJ
| | | | | | | | | | - Harsukh Parmar
- Department of experimental Medicine, Hoffmann-La Roche, Nutley, NJ
| | - Salman Siddiqui
- Department of Infection, Inflammation and Immunity and Health Sciences, Institute for Lung Health, University of Leicester, Leicester, United Kingdom
| | - Sumit Gupta
- Department of Infection, Inflammation and Immunity and Health Sciences, Institute for Lung Health, University of Leicester, Leicester, United Kingdom; Radiology Department, Glenfield Hospital, University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
| | - Chris E Brightling
- Department of Infection, Inflammation and Immunity and Health Sciences, Institute for Lung Health, University of Leicester, Leicester, United Kingdom.
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Atta H, Seifeldein GS, Rashad A, Elmorshidy R. Quantitative validation of the severity of emphysema by multi-detector CT. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2015. [DOI: 10.1016/j.ejrnm.2014.11.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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Liu HW, Nugent Z, Clayton R, Dunscombe P, Lau H, Khan R. Clinical impact of using the deterministic patient dose calculation algorithm Acuros XB for lung stereotactic body radiation therapy. Acta Oncol 2014; 53:324-9. [PMID: 23957683 DOI: 10.3109/0284186x.2013.822552] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE To evaluate the clinical impact of using the deterministic dose calculation algorithm, Acuros XB, for early stage lung cancer patients undergoing stereotactic body radiotherapy (SBRT). MATERIAL AND METHODS Seventy-seven stage I non-small cell lung cancer patients who underwent lung SBRT from 2008 to 2012 at our center were included in this study. All treatment plans originally calculated by the anisotropic analytical algorithm (AAA) were recalculated using the AAA and Acuros XB algorithms with identical monitor units and beam arrangements. The dose, dose distribution, conformality number (CN) and heterogeneity index (HI) of the target were determined for each plan. A paired matched t-test was used to evaluate the difference between the mean dose, the dose distribution, and the CN and HI for the target. The importance of tumor (volume, location), patient (pulmonary functional, body mass index) and treatment (number of SBRT beams) on the dose distributions obtained from the two algorithms was statistically determined using linear regression analyses. RESULTS The mean target dose was same for both algorithms. Compared to AAA, a small and significant difference in dose distribution in the target was found for the Acuros XB algorithm, resulting in lower conformity (-2.1%, p < 0.0001) and higher heterogeneity (p < 0.0001) of dose. Single logistic regression identified pulmonary function, number of beams and target location as being correlated with the difference of CN between the two calculations. Multivariate analysis indicated that the patient's pulmonary function (p = 0.0296) was the only predictor for the difference in conformality between the two dose calculation algorithms. CONCLUSIONS In lung SBRT, the patient's pulmonary function is responsible for the difference in target dose distribution between the Acuros XB and AAA algorithms. The Acuros XB algorithm could be used to advantage in patients with compromised pulmonary function based on its accurate modeling of lung tissue in comparison to AAA.
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Affiliation(s)
- Hong-Wei Liu
- Department of Radiation Oncology, Tom Baker Cancer Center , Calgary , University of Calgary , Alberta , Canada
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